Potential of Recovery Capital, The

THE POTENTIAL OF
RECOVERY CAPITAL

This paper

This short paper outlines the concept of recovery capital and discusses the
impact that the accumulation of individual success has on groups and
communities. It seeks to define recovery capital, to capture its flavour and
principles, and to look at the intrinsically social forces that are at play in
shaping change and in growing communities of recovery. It also outlines
how we will be taking forward these ideas in our action research.

Forthcoming RSA papers will discuss how the ideas in this report are being
operationalised, and what the lessons are to date in trying to embed
recovery-oriented practice and behaviour; and will report on our recent work
in West Sussex.

About the authors

David Best is Chair of the UK Recovery Academy, Chair of the Scottish Drugs
Recovery Consortium and a researcher at the University of the West of
Scotland. He is currently involved in researching recovery pathways and in
developing training manuals in recovery approaches to treatment.

Alexandre B. Laudet, Ph.D, is an expert in addiction recovery from the US.
Her federally funded research in the past 15 years has focused on
elucidating what helps people with drugs and/or alcohol problems quit
drinking or getting high and how they stay in recovery. A social
psychologist, her main goals are to build and help translate the science of
recovery into services and policy that create opportunities for long-term
recovery and improved quality of life for people with substance problems.

RSA Projects

CITIZEN
POWER

PETERBOROUGH

“voluntarily sustained control over
substance use which maximises
health and wellbeing and
participation in the rights, roles
and responsibilities of society”

— UK Drug Policy Commission,
defining recovery capital

“the essence of recovery is a lived
experience of improved life quality
and a sense of empowerment, ...
the principles of recovery focus on
the central ideas of hope, choice,
freedom and aspiration”

— Best and Laudet

Betty Ford Institute
Consensus Panel (2007)
‘What is Recovery?

A Working Definition from
The Betty Ford Institute’,
Journal of Substance
Abuse Treatment, Vol. 33,
pp221-228

UK Drug Policy
Commission, (2008)
Recovery Consensus
Statement,
www.ukdpc.org.uk/
Recovery_Consensus_
Statement.shtml

Deegan, P. E. (1988)
Recovery: the lived
experience of rehabilitation.
Psychosocial Rehabilitation
Journal, 11, 11-19.

INTRODUCTION

The addictions field is now overflowing with references to ‘recovery’ with
service providers and workers increasingly designated as ‘recovery-focused’,
although in many areas there is confusion as to what this means in practice
and what needs to change. There is an increasing awareness that people do
recover, but we have limited knowledge or science of what enables recovery
or at what point in the journey recovery is sparked and made sustainable.

There is also the recognition that recovery is something that is grounded in
the community and that it is a transition that can occur without professional
input, and where professional input is involved, the extent of its role is far
from clear. We are also increasingly confident that recovery is contagious
and that it is a powerful force not only in transforming the lives of
individuals blighted by addiction but in impacting on their families and
communities as well.

WHAT DO WE MEAN BY RECOVERY AND
RECOVERY CAPITAL?

Researchers and clinicians have devised the construct of ‘recovery capital’
to refer to the sum of resources necessary to initiate and sustain recovery
from substance misuse. Before discussing this construct in more detail, it
is first necessary to explain what we mean by recovery.

In the US, the Betty Ford Institute Consensus Panel (2007, p. 222) defined
recovery as “a voluntarily maintained lifestyle characterised by sobriety,
personal health and citizenship”.' Subsequently, the UK Drug Policy
Commission (2008, p.6) followed up this statement with a definition of
recovery as “voluntarily sustained control over substance use which
maximises health and wellbeing and participation in the rights, roles and
responsibilities of society”. Both of these definitions involve three primary
component parts — wellbeing and quality of life, some measure of
community engagement or citizenship, and some measure of sobriety.”

In contrast, the definition from mental health recovery is typically more
focused on the quality of life component regardless of the others. Deegan
(1988) has argued that “recovery refers to the lived experience of people as
they accept and overcome the challenge of disability... they experience
themselves as recovering a new sense of self and of purpose within and
beyond the limits of the disability”?

What is clear, however, is that the essence of recovery is a lived experience
of improved life quality and a sense of empowerment; that the principles

of recovery focus on the central ideas of hope, choice, freedom and
aspiration that are experienced rather than diagnosed and occur in real life
settings rather than in the rarefied atmosphere of clinical settings. Recovery
is a process rather than an end state, with the goal being an ongoing quest
for a better life.

THE POTENTIAL OF RECOVERY CAPITAL

“Those who possess larger
amounts of social capital, perhaps
even independently of the intensity
of use, will be likely candidates for
less intrusive forms of treatment”
— Granfield and Cloud

“.... the breadth and depth of
internal and external resources
that can be drawn upon to initiate
and sustain recovery from AOD
[alcohol and other drug] problems”

— Granfield and Cloud, defining recovery capital

4 Bourdieu, P. (1980)
The logic of practice.
Polity: London

5 Granfield, R. and Cloud,
W. (2001) ‘Social Context
and “Natural Recovery”:
The Role of Social Capital
in the Resolution of Drug-
Associated Problems’,
Substance Use and
Misuse, Vol. 36, pp1543-
1570

6 Granfield, R. and Cloud,
W. (1999) Coming clean:
Overcoming addiction
without treatment.

New York: New York
University Press

7 White, W. and Cloud, W.
(2008) ‘Recovery Capital:
A Primer for Addiction
Professionals’, Counselor,
Vol. 9, No. 5, pp22-27

8 Ibid.

With recovery conceptualised as a process in this way, recovery capital
refers to the sum of resources that may facilitate the process. The notion

of social capital initially developed in the field of sociology, where

Pierre Bourdieu (1980) described it as one of three resource forms along
with economic and cultural capital as the basic resources for power.* When
this concept was applied to the addictions field, Granfield and Cloud (2001)
suggested that “Those who possess larger amounts of social capital,
perhaps even independently of the intensity of use, will be likely candidates
for less intrusive forms of treatment”s

However, social capital in this sense does not mean only the social resources
that an individual can draw upon — their parents and families, partners,
friends and neighbours when times are tough. It also implies the person’s
engagement and commitment to the community and their willingness to
participate in its values.

Further, Granfield and Cloud (1999) defined recovery capital as “.... the
breadth and depth of internal and external resources that can be drawn
upon to initiate and sustain recovery from AOD [alcohol and other drug]
problems”.° In the same paper, they summarise early evidence among
naturally recovering individuals (people who did not seek professional
treatment or participate in mutual aid support groups) suggesting that both
the quality and the quantity of recovery capital play a major role in
predicting recovery success both in and out of treatment, and crucially that the
growth of recovery capital can signal a ‘turning point’ in addiction careers.

White and Cloud (2008) assert that the type of interventions that will be
appropriate will depend in part on the balance of recovery capital and
problem severity /complexity.’? They represent this in a ‘quadrant model’ as
shown in Table 1 below, where people can be allocated to one of four cells
(although this is a shorthand for people’s overall ratings of recovery

capital and problem profile). Thus, people with high recovery capital and low
problem severity may be appropriate for brief interventions of various
types. People with high recovery capital but also high problem severity may
be appropriate for out-patient detoxification with intense community
support. White and Cloud argue that people with low problem severity and
low recovery capital may be appropriate for residential rehabilitation with
appropriate follow-up and people with low recovery capital and high
problem severity may need a combination of intensive interventions.

Table 1: Recovery Capital / Problem Severity Matrix
(re-produced with permission from White and Cloud, 2008)°

High Problem Severity/

High Recovery Capital comet

Low Problem Severity/

Complexity Low Recovery Capital

THE POTENTIAL OF RECOVERY CAPITAL

9 Cloud, W. and Granfield, W.

(2009) Conceptualising
recovery capital: Expansion
of a theoretical construct,
Substance Use and Misuse,
42, 12/13, 1971-1986

10

Christakis, N. A. and
Fowler, J. H. (2007)
“The Spread of Obesity
in a Large Social
Network Over 32 Years”
New England Journal of

Medicine 357 (4): 370-379

11

Christakis, N. A. and
Fowler, J. H. (2008) “The
Collective Dynamics of
Smoking in a Large Social
Network” New England
Journal of Medicine 358
(21): 2249-2258

Consistent with Deegan’s definition of recovery in the mental health field,
this model makes no assumption that those high in addiction severity/
complexity will be low in recovery capital. However, the influence of
change in recovery capital (increases or decreases) on subsequent patterns
of substance use and related problems remains an unanswered question.

WHAT ARE THE KEY COMPONENTS OF
RECOVERY CAPITAL?

Cloud and Granfield (2009) recently revisited their initial concept and have
argued that there are four components to recovery capital:?

1 Social capital is defined as the sum of resources that each person has as
a result of their relationships, and includes both support from and
obligations to groups to which they belong; thus, family membership
provides supports but will also entail commitments and obligations to
the other family members.

2 Physical capital is defined in terms of tangible assets such as property and
money that may increase recovery options (e.g. being able to move away
from existing friends /networks or to afford an expensive detox service).

3. Human capital includes skills, positive health, aspirations and hopes, and
personal resources that will enable the individual to prosper. Traditionally,
high educational attainment and high intelligence have been regarded as
key aspects of human capital, and will help with some of the problem
solving that is required on a recovery journey.

4 Cultural capital includes the values, beliefs and attitudes that link to
social conformity and the ability to fit into dominant social behaviours.

Although the focus here is primarily on individual factors, it is the meshing
of three of these components — social, human and cultural capital - that
may be particularly important in assessing recovery capital at a group or
social level.

WHAT DOES RECOVERY CAPITAL MEAN
AT A COMMUNITY LEVEL?

In social epidemiology, Christakis and Fowler (2007) reported on the
increased risk rates for obesity in up to three degrees of separation from

a target individual such that a person’s odds of becoming obese increased by
57% if they had a friend who became obese, with a lower risk rate for
friends of friends, lower again at three degrees of separation, and with no
discernible effect at further levels of remove.’° Moreover, if the friend is
perceived to be a close friend then the risk rate is increased. Repeating this
social network analysis for smoking, Christakis and Fowler (2008)

found that smoking cessation by a spouse decreased a person’s chances of
smoking by 67%, while smoking cessation by a friend decreased the
chances by 36%. The average risk of smoking at one degree of separation
(i.e. smoking by a friend) was 61% higher, 29% higher at two degrees of
separation and 11% higher at three degrees of separation.”

THE POTENTIAL OF RECOVERY CAPITAL

12

Christakis, N. A. and
Fowler, J. H. (2010)
Connected: The Amazing
Power of Social Networks
and How They Shape Our
Lives, Harper Press: London

13

Best, D. and Gilman, M.
(2010) Recovering
Happiness, Drink and
Drugs News, 15 February
2010

14

Laub, J.H. and Sampson.
R.}. (2003) Shared
Beginnings, Divergent
Lives: Delinquent Boys to
Age 70. Cambridge, MA:
Harvard University Press

In “Connected”, Christakis and Fowler (2010) assessed the effect of social
contagion in emotions and the extent to which this reaches beyond
immediate social networks, which they refer to as hyperdyadic spread.”
Using happiness as the topic for investigation, they reported that, ifa person’s
friend is happy, there is a 15% increase in the chances that the target will be
happy, but that even at a further degree of separation there is an increase of
around 10% and at three degrees of separation, the increased likelihood of
happiness is 6%. This is a critical issue in the development of interventions
and policies that attempt to promote recovery as it would suggest that
focusing exclusively on individuals underestimates the impact of key icons
of recovery and of recovery communities. Thus, there is evidence for the
social transmission of some of the key elements of recovery capital, and we
do not have to conceptualise it exclusively as the property of an individual.

The development of recovery ‘champions’ as charismatic and connected
community figures who are visible examples of success provides not only
the opportunity for ‘social learning’ for those who claim that recovery is
not possible, but also increases the waves of impact within local communities
for recovery spread. Similarly, the growth of vibrant recovery groups

and recovery-oriented systems of care may well provide ready-made social
supports for individuals starting out on their recovery journeys

(as has often been attributed to mutual aid groups, particularly Alcoholics
Anonymous) while also providing the scaffolding for the development of
the human and physical capital that are likely to be part of the
developmental journey of recovery. In other words, recovery champions
may be the key contagion that allows the ‘viral spread’ of recovery capital.

Within the addictions field, Best and Gilman (2010) have argued that the
growth of recovery has a ripple effect that confers benefits on families but
also serves to generate ‘collective recovery capital’ that provides support and
hope for those in recovery and that engages people in a range of activities

in the local community.” This process translates into active participation in
community life and ‘giving something back’ by creating a collective
commitment in recovery groups to community engagement and immersion.
In other words, the recovery community acts and is seen as a positive force
in the local community and a resource for that community that goes beyond
managing substance misuse issues.

WHAT DOES THIS MEAN FOR PROFESSIONALS
AND ADDICTION AGENCIES?

As Laub and Sampson (2003) have reported with respect to the predictors
of long-term desistance from crime, it is not direct treatment effects that
will trigger the growth of recovery capital; rather, it is likely to be a range of
life events and personal and interpersonal transitions:

— attachment to a conventional person (spouse);

— stable employment;

— transformation of personal identity;

— ageing;

— inter-personal skills; and

— life and coping skills.

THE POTENTIAL OF RECOVERY CAPITAL

The RSA

RSA Projects put enlightened thinking to work in practical ways.
We aim to discover and release untapped human potential for
the common good. By researching, designing and testing new
social models, we encourage a more inventive, resourceful and
fulfilled society.

The RSA Commission on Illegal Drugs, Communities and
Public Policy published its report, Drugs — facing facts,
in 2007, which argued, inter alia, for a more tailored and
expansive approach to drug services.

Following this report, and with our modern mission to extend
our thought leadership into practical action on the ground, we
are working with West Sussex Drug and Alcohol Action Team
and partners to develop and test a user-centred approach to
personalised recovery.

Building on this work, we have launched a new project to
explore how to develop a broad recovery community

RSA Peterborough Recovery Capital Project

The RSA is working with Peterborough City Council and partners
to put the ideas in this paper into practice as part of the broader
Citizen Power Programme of work which sets out a vision

for active citizenship across the City and seeks to realise it with
local stakeholders.

There are strong overlaps between the notion of recovery
capital and its domains, and the RSA’s account of individual
and collective civic health. Broadly, the latter includes being
engaged in civic life; acting in an other-regarding,

pro-social manner; being resilient in the face of change and
shocks; having sufficient self-reliance to make change and to
participate in civic life; and being resourceful and creative in
problem-solving and in the face of scarcer resources.

The RSA’s Recovery Capital project will work with current

and former substance misusers to map and understand their
recovery capital. We will then work with substance misusers,
service providers and a wide range of other stakeholders to
re-design services for recovery, foster recovery capital, and
mobilise community assets to support recovery journeys and
the active participation in civic life.

15 Ajayi, S., Billsborough,
)., Bowyer, T., Brown,
P., Hicks, A., Larsen, J.,
Mailey, P., Sayers, R.,
and Smith, R. (2010)
Getting Back into the
world: Reflections on lived
experiences of recovery.
Rethink recovery series:
volume 2 www.rethink.
org/intotheworld

However, this does not mean that treatment providers or commissioners
have nothing to offer — they are often best placed to act as guides

to recovery communities, and they are essential in activating the basic
health supports that are needed. In “Getting back into the world”, the
mental health recovery group, Rethink (2010), argued that the starting
point for a recovery journey requires three components — a safe place
to live, effective control over symptoms and general health problems,
and basic human rights supports.’ While not all clients are looking for
recovery guides, the sine qua non of treatment services and workers
should be to enable their clients to get to the starting blocks of the
recovery journey and to enable and support recovery activities that will
be community-based and socially grounded.

RECOVERY CAPITAL AS COMMUNITY ENGAGEMENT

This overview of recovery capital has focused on recovery from addictions
and the increasing recognition that recovery is not only possible, it is

the reported experience of many people who have (had) addiction
problems. Recovery unfolds in the lived, physical community as well as in
the substance misusing communities and it has significant ramifications
for those wider communities. The growth of recovery capital as

a collective, community concept will involve mutual empowerment,
support and recovery contagion in substance misusing groups, but it will
manifest itselfin improved functioning for the family and the wider
community. The growth of recovery capital is, as far as we currently know,
idiosyncratic and personal, but its manifestation is inherently social

and community-based and its impact can be measured in terms of those
lived communities.

What this means is that at a systems level — the Drug Action Team in
England or the Alcohol and Drug Partnership in Scotland — it is meaningful
to conceptualise and measure recovery capital as the sum of resources and
supports available to people starting recovery journeys. This will include
the range and dynamism of recovery support groups, the local champions
of recovery and the services that provide continued and ongoing care. This
resource is the community asset that we should aim for as the foundation
stone of recovery-oriented systems of care.

THE POTENTIAL OF RECOVERY CAPITAL